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ACL injuries in the Female Athlete

ACL injuries in the Female Athlete

Book Review

This 534-page book is accompanied by a DVD Rom and an eBook version is also available. Not for the casual reader, this book is aimed at sports coaches and researchers.

In the preface the editors make the point that for ACL injuries a paradox exists in that researchers are still trying to understand the mechanisms and risk factors of ACL injury in females, while intervention programmes already exist to reduce this risk, with a variation in effectiveness.

The first chapters are written by the editors and focus on the anatomy and biomechanics of the ACL, ACL injury and the differences between males and females that may be relevant to ACL injury. They look at the studies of complete ACL rupture where surgery was not undertaken, and why some people appear to cope well despite a complete ACL rupture. They follow by discussing surgical ACL reconstruction, and note that there are very few level 1 studies comparing conservative and surgical management.

Before progressing to the gender issues, a chapter by Dowling and Andriacchi goes into some detail about the shoe-surface interaction in non-contact injuries, comparing shoe and cleat design, a variety of natural and synthetic playing surfaces and weather issues.

Subsequent chapters focus on the gender differences relevant to ACL injury – neuromuscular, gait mechanics, muscle activation patterns during running, cutting or jumping, core stability, the role of the hip, and central and peripheral fatigue. A further chapter then goes into tests designed to identify the athlete at risk.

A major section of several chapters examines in depth the literature relating to a number of ACL injury prevention programmes. The editors discuss in depth their own Sportsmetrics programme in a very informative and well-illustrated chapter. This is a 60-90 minute, 3x a week for 6 weeks preseason programme. They highlight, however, that many athletes, parents and coaches are only interested in performance enhancement, so they have also developed a series of sports specific programmes that combine the essential components of Sportsmetrics with other exercises and drills to improve dynamic balance, agility, speed, strength and aerobic conditioning –

Sportsmetrics Basketball

Sportsmetrics Volleyball

Sportsmetrics Soccer

Sportsmetrics Tennis

Details and illustrations of the full programme for each of these are given.

Silvers and Mandelbaum follow with a chapter on the Santa Monica Experience of their own programme (PEP – Prevent Injury and Enhance Performance), which is a dynamic 20 minute warm-up in season for soccer players that has been shown to reduce ACL injury significantly in high-school aged and collegiate soccer players. They discuss the incorporation of elements of their programme into the FIFA 11+ programme, which is a 20 minute on-field warm up completed prior to training or a game.

The editors then review the literature related to several warm-up programmes, including the FIFA 11+, but they found only two programmes – the PEP and the KIPP – had a statistically significant effect in reducing the ACL injury rate. They point out that poor study design affects many of the studies, and that future studies should be better able to determine the value of individual warm-up programmes in preventing knee ligament injuries.

An interesting chapter follows, discussing -

comparison of the outcome of 10-20 minute warm-up programmes conducted in season with longer 60-90 minute, 3x a week for 6 weeks preseason programmes

the age at which intervention programmes should be initiated

the degree to which one can compare programmes across different sports

the effect of each programme on the individual components thought to be important in preventing ACL injury

The final chapters focus on the knee after ACL reconstruction, and the prevention of re-injury. The book closes with an evaluation of how global awareness might be increased and how these kinds of intervention programmes could be rolled out across the world.